When Esra*, a 27-year-old from Istanbul fell pregnant by mistake, she knew she had no choice but to get an abortion.
Abortion is legal on request in Turkey to all women up to the 10th week of pregnancy, and up to the 20th week for medical reasons. According to the law, it should be done in any public hospital for free.
Yet Esra visited one hospital after another in Istanbul, trying to arrange a termination, and was turned away from them all.
“I was told over and over, you can’t get an abortion here, we don’t perform it,” says Esra. “I told them that it was my right, but they still refused.”
In growing desperation, she visited several private hospitals but was told they would charge a fee that she had no way of paying on her teacher’s salary. “The weeks were passing and I was more and more nervous, imagining that I would end up in some clandestine and unhealthy place,” she says.
When she eventually found a private clinic she could afford, she still had to sit through a lecture by the resident gynaecologist, telling her she should try to persuade her partner to marry and have the baby.
The operation seemed to go smoothly, but three weeks later she began to bleed.
“I had a fever, and pieces of coagulated blood were coming out of my body,” she says. At the nearest public hospital, doctors performed an emergency operation after discovering her abortion was incomplete. “They treated me in one of the hospitals where I had been told that no abortions are performed. It would have been so easy and safe if they had just agreed in the first place,” says Esra.
She now worries that she will be unable to have children after experiencing persistent pain after her operation.
In Turkey, women’s right to access free and safe medical abortions is increasingly under threat. After the law legalising abortion was introduced in 1983, the number of abortions rose over the next five years to 45 per 1,000 women aged between 15 and 49. Ten years later, it had fallen to 25. A study by Kadir Has university found that by 2020, there was not a single public hospital performing on-demand abortions in Istanbul.
According to the survey, only eight of Turkey’s 81 provinces have at least one public hospital performing on-demand abortions, and only two of them have more than one. From the 295 clinics surveyed, 14% said they would not perform abortions for reasons other than a medical emergency.
The study found that health workers often tell women that abortion is forbidden, or legal only for married women. Single women either cannot access the operation or must bring a permit from the local prosecutor’s office. All of this is false.
The Guardian interviewed more than a dozen Turkish women who had all had abortions in the last three years. All said they were forced to seek terminations in private clinics, since public hospitals refused to perform the procedure. They said they were told in some hospitals that it was forbidden for them to carry out terminations.
“There is a de facto ban in many places,” explains Filiz, a nurse at a public hospital in Istanbul where abortions are not performed. “Under Turkish law, a doctor cannot tell a woman she cannot have an abortion, but refusal is very common, forcing women to go begging from hospital to hospital,” says Filiz, who prefers not to give her surname.
This de facto ban appears to be shaped by the increasingly populist and hardline approach to abortion taken by the Turkish government. In 2012, Recep Tayyip Erdoğan, who was prime minister at the time, described abortion as “murder”, and proposed a bill to restrict it to only the first six weeks. Massive protests erupted in the country and the proposal was never voted into law.
Yet reproductive health activists say that, since then, many parts of the public health system have fallen into line with the government’s increasingly anti-abortion position, underlined by Erdoğan’s often-repeated wish that “every woman should have at least three children”.
“We have increasingly seen hospital administrations put pressure on physicians to not practise abortions,” says Irmak Saraç, an obstetrician and member of the women’s commission at the Istanbul Medical Chamber. “The conservative atmosphere and debate over the foetus’s right to life is increasing the rate of conscientious objection.”
She adds: “On many occasions, the family planning units where abortions were performed have been closed, or new doctors have not been assigned when the obstetricians retired.”
A private clinic told the Guardian that the fee for an abortion is about 3,000 liras (£146), although prices increase with each passing week of pregnancy. This makes access to an abortion difficult for many women in a country where the minimum monthly wage is about £243 and only 30% of women of working age are in formal employment.
Many of the women who spoke to the Guardian said they had faced hostility, discrimination and abuse from healthcare workers while trying to access their right to a safe and legal abortion.
Ilknur, 28, is from Köycegiz, a small town on the Aegean coast. A year ago, she became pregnant and travelled to Istanbul to have an abortion. “Coming from a small town, I was afraid the doctor would know my parents, and they would find out,” she says.
Ilknur was five weeks’ pregnant, and with the help of two friends called more than 20 public hospitals in Istanbul. All refused her an abortion. “I began to get really scared because I just presumed it would be straightforward,” she says. “I even talked to hospitals in other cities near Istanbul but found nothing.”
Two weeks passed, and Ilknur started consulting private clinics. Using her savings, she paid 3,500 liras for the abortion. “All the time, I kept wondering about women in more conservative cities who don’t have this kind of money,” she says.
On her first visit to the clinic, the doctor was kind and courteous. “But when I went in for the abortion, the same doctor and the nurse started behaving very coldly,” she says.
Ilknur was given a local anaesthetic but a few minutes into the procedure she felt a strong pain in her stomach that made her move her legs. “The doctor said to me: ‘Open your legs, this is nothing. If you have been able to open your legs to get pregnant, now you can too’.”
Ilknur was stunned. “I just couldn’t look at him again. The nurse didn’t say a thing. I was so embarrassed.”
After the abortion, she didn’t return to the clinic for a check-up. She thought about filing a complaint but didn’t want her family to find out about her abortion.
Across Turkey, some healthcare workers – including Filiz – are now attempting to help women access their right to a safe abortion, drawing up lists of medical staff still willing to carry out free abortions.
Filiz says: “Several of us wrote up a list of doctors who agree to perform abortions, and we distributed it among grassroots organisations and feminist groups to help other women. But it is impossible to get this information to all of those who need it.”
*Names have been changed to protect identities
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